Allergic rhinitis, nasal congestion and nasal polyposis are significant medical issues that affect millions of people around the world. The nasal turbinates are one of the major causes of nasal obstruction. The turbinates can become hypertrophied and produce increased amounts of mucous when irritated by environmental allergens, hormones in the body, or some medicines. Steroids can decrease the reactivity of the turbinates to allergens and hormones. Steroids can be delivered in multiple ways to the human body. For example, steroids can be injected into veins or muscles to decrease inflammation. A potential problem that can be associated with the injection of steroids into veins or muscles is that there can be side effects to the entire body when this is done. Another way that steroids can be delivered to the human body is via an aqueous solution containing steroid molecules that is sprayed, for example daily or twice daily, into the nose to help decrease inflammation and hypertrophy. There are also some aerosol preparations available. However, it can be difficult for a patient to comply with a daily or twice daily application schedule, and the application may not be done as prescribed. This can lead to treatment failures. There can also be a significant amount of nasal bleeding because the sprays can thin the mucosa on the septum.
The application of steroids to the inferior turbinate decreases the size of the turbinate therefore decreasing nasal obstruction and allowing the patient to breath better. In the past, physicians would sometimes inject aqueous solutions of steroid directly into the turbinates. In many cases this worked well for control of allergic rhinitis and shrunk the inferior turbinates considerably for months at a time. However, this practice has been all but abandoned because some patients developed blindness after injection within about twenty-four hours of injection, and usually within one hour of injection. It is hypothesized that the small size of the particle in an aqueous solution would travel within a vein in the turbinate back to the vein going to the eye and cause blindness.
Other ways of decreasing the size of the turbinate can include destruction of the native tissue either through “chewing” the tissue and causing scarring, or by ablation with radiofrequency or electrocautery. These are inherently destructive to the tissue and cause damage to the native tissue. They also do not fix the allergic component of the problem, only the hypertrophy and nasal congestion components.
Patients also can develop polyps in their nose, which can be caused by allergies to substances in the environment. These patients often need surgery to remove the polyps so that they can breathe through their nose. These polyps are actually overgrowths of mucosa which can block the nasal passage. The polyps are also susceptible to injection with aqueous steroid solutions and shrink up when injected. A potential problem with this approach is that the liquid preparations stay in the system for only a short time and the polyps increase in size again once the steroids are gone.